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Anxiety

Anxiety

Anxiety is our natural reaction to stress and is typically considered as a healthy response as it makes us alert. But if someone experiences high levels of anxiety regularly, then it can be a sign of an anxiety disorder.

What Is Anxiety?

It is a mental state and emotion that causes distress, increased arousal, expectancy, worries, tension, fear, nervousness, inner mental turmoil & specific behavior patterns. According to a 2002 study 1 , it is “a psychological, physiological, and behavioral state induced in animals and humans by a threat to well-being or survival, either actual or potential.” Anxiety can also lead to certain physical effects, such as rapid heartbeat, dizziness, fatigue, trembling, high blood pressure, sweating, muscular tension and other somatic issues. It can also lead to intrusive and repetitive thoughts or worries, abnormal behavior and avoidance of situations that trigger fear or worry. If you experience disproportionate levels of anxiety for over 6 months which impair your ability to perform daily tasks, then you may be suffering from a type of anxiety disorder.

The primary function of anxiety is to make an individual alert about anticipated threats and dangers in the environment so that we pay attention and become ready for action. It is characterized by feelings of –

  • Uneasiness
  • Restlessness
  • Tension
  • Nervousness
  • Dread
  • Excessive fear

We may often feel anxious before certain challenging tasks, such as taking a test or meeting a deadline at work or giving a presentation. This feeling can help us stay focused and enable us to overcome the challenge or make an important decision. However, for individuals suffering from anxiety disorders, the severity of symptoms can be intense which can make them overwhelmed and adversely affect their daily performance. According to a research paper 2 , “Anxiety may be defined as apprehension, tension, or uneasiness that stems from the anticipation of danger, which may be internal or external.” The research also found that around 2%-4% of the general population tend to experience symptoms that can be classified as an anxiety disorder.

Understanding Anxiety

“Anxiety is a complex mixture of cognitive, affective, behavioral, and somatic components, and it has complex relations to other aspects of motivation such as arousal,” explains a 2003 study 3 . It is typically considered as a natural overreaction to an event perceived as threatening or dangerous. Although it can make us more focused, it can also lead to intense fear making us withdraw in certain situations that are associated with an earlier traumatic event or has led to anxiety before. However, such feelings may play a crucial role in our survival. Studies 4 have found that it is a mental defense system that “plays a central role in ensuring individual and species survival from dangers. The cost of its activation is a decrease in freedom in favour of an increase in safety.”

Anxiety, which leads to hyperarousal and increased sensitivity, kept our ancestors safe by alerting them about incoming predators and other dangers in the environment. By putting the body in high alert mode and triggering the fight-or-flight response 5 , it allows us to take necessary action and ensure our survival, either by confronting or running away from possible threats. Although we may not need to protect ourselves from predators nowadays, feelings of anxiousness still function to protect us from any potential dangers. Hence, important life issues, like career, finances, education, health, family and others can make us feel anxious even though these may not necessitate the activation of the fight-or-flight response. In certain other situations, the feelings of nervousness can help us avoid danger such as when crossing the street or walking alone at night.

One 2013 study 6 has found feeling anxious can improve our “ability to detect and avoid danger” which, under the right circumstances can be adaptive. The researchers believe that it is a reaction to unpredictable and prolonged dangers and threats which involve cognitive, affective and physiological changes. However, it should be noted that anxiety is separate from fear, which arises from predictable and acure external environmental threats. “Fear and anxiety are dissociable at the behavioral, neural, and pharmacological level,” adds the study. But this mental state can become maladaptive if it is adopted persistently.

Anxiety At A Glance

  1. Anxiety is our natural reaction to stress and is typically considered as a healthy response as it makes us alert.
  2. The main symptom of anxiety disorders is excessive fear or worry.
  3. The primary function of anxiety is to make an individual alert about anticipated threats and dangers in the environment so that we pay attention and become ready for action.
  4. Although anxiety is a normal emotion, anxiety disorders are mental health conditions that require treatment and support.
  5. The two main treatments for anxiety disorders are psychotherapy and medications.

Anxiety Disorders

Although most of us feel anxious from time to time, anxiety disorders can be a serious problem. Anxiety disorders refer to a set of psychiatric conditions marked by intrusive recurring thoughts or worries, panic and constant fear which gets worse over time. These are different from normal anxiety as it lasts persistently for over 6 months. It includes conditions 7 such as generalized anxiety disorder, specific phobias, social anxiety disorder, panic disorder or agoraphobia & others. It can adversely affect and impair a person’s ability to perform daily activities and make them avoid anxiety-inducing situations like school, work or social situations that trigger their symptoms. Such feelings can lead to age inappropriate or disproportionate reactions than the actual stressor that affect their education, career and relationships.

According to a 2017 study 8 , “Anxiety disorders are the most prevalent psychiatric disorders, and are associated with a high burden of illness.” These are usually underrecognized, underdiagnosed and undertreated. Research 9 shows that global prevalence is around 7.3%, with specific phobias being the most common. It was also found that women 10 are 2 times more likely than men to develop these disorders. These conditions also have a high comorbidity with depressive disorders. However, with therapy and medication, the symptoms can be reduced and managed effectively.

Types Of Anxiety Disorder

Types Of Anxiety Disorder
Anxiety


According to research 11 , anxiety disorders include the following types of mental illnesses based on American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5) –

1. Generalized Anxiety Disorder (GAD)

GAD 12 is characterized by extreme, unrealistic and constant worry about different aspects of daily life, such as school, work, finance, health, relationships, future etc. It causes excessive worry, fear, restlessness, irritability and fatigue making the person feel persistently overwhelmed. According to a 2021 study 13 , “Excessive worry is the central feature of generalized anxiety disorder,” and it is “not attributable to any physical cause.”

Read More About Generalized Anxiety Disorder Here

2. Separation Anxiety Disorder (SAD)

SAD is regarded as one of the “most common 14 childhood anxiety disorders.” It involves extreme worry and dread of a perceived or actual separation from an attachment figure. It is generally an abnormal and exaggerated level of concern for their age & development level. It can also be observed in adults as well and can impair daily functioning & quality of life. “SAD is a disorder that can cause a great deal of distress and impairment. It is quite likely that, if untreated, SAD can lead to numerous negative psychosocial outcomes,” explains a 2005 study 15 .

3. Social Anxiety Disorder

Research 16 shows that social anxiety is a persistent and intense fear of social situations, especially when interaction or performance is involved. The person may be afraid that they will be criticized, humiliated, rejected or embarrassed. Also known as social phobia 17 , this seriously disabling condition is observed in about 13% of the population. According to a recent study 18 , as the person fears that they will be judged, exposure to social gatherings leads to anxious and fearful feelings. The study adds “These individuals often avoid the social situations that they fear or endure them with intense anxiety, which results in impairment in social, occupational, or other realms important to function in society.”

4. Specific Phobias

These refer to an intense, unreasonable and overwhelming fear of creatures, things or situations that pose little to no threat. The fear can be so severe that the sufferer can take extreme measures to avoid their object of fear. “Patients with specific phobias experience anxiety and panic attacks along with unreasonable fear of exposure or anticipated exposure to a feared stimulus,” explain researchers 19 . According to studies 20 , global lifetime prevalence of this condition varies from 3% to 15%. It has also been found that fear of animals and heights are the most common.

5. Agoraphobia

This phobic-anxious syndrome 21 refers to an unreasonable fear of certain places and situations, such as open spaces, crowded places, public transportation, enclosed spaces etc. This can lead to panic attacks, feelings of entrapment, embarrassment or helplessness in the sufferer. The person may avoid such places or situations to reduce panic-like symptoms. “Agoraphobia is the anxiety that occurs when one is in a public or crowded place, from which a potential escape is difficult, or help may not be readily available,” explains a 2021 study 22 .

6. Panic Disorder

This type of anxiety disorder involves unexpected and recurrent panic attacks 23 along with persistent worry and fear even in the absence of any potential threats or danger. According to research 24 , panic attacks may occur without any particular warning, which is a hallmark feature of panic disorder. “There is often not a specific trigger for the panic attack. Patients suffering from these attacks self-perceive a lack of control,” add the researchers. Common symptoms 25 include increased heart rate, trembling, shaking, sweating, shortness of breath, chest pain, dizziness, nausea, tingling sensations, depersonalization, derealization, fear of losing control etc.

Read More About Panic Disorder Here

7. Selective Mutism

The sufferer is unable to speak 26 in social situations although they may speak normally in otherwise. Observed primarily in children and adolescents, this mainly occurs due to disproportionate expectations to speak. “Selective mutism is a rare and multidimensional childhood disorder that typically affects children entering school age,” states a 2010 study 27 .

8. Substance/Medication-Induced Anxiety Disorder

Here anxiety occurs primarily as a result of substance (drugs or alcohol) use, withdrawal or during medical treatment. It can cause panic attacks or significant emotional upset. A research paper 28 explains that substance/medication-induced disorders refer to “depressive, anxiety, psychotic, or manic symptoms that occur as a physiological consequence of the use of substances of abuse or medications.”

9. Anxiety Disorder Due to Other Medical Conditions

This disorder involves symptoms which are caused by physiological effects of other medical disorders and illnesses. Here, anxious feelings typically develop directly due to the onset of another medical condition 29 .

Symptoms Of Anxiety

Symptoms Of Anxiety
Anxiety


Although the different forms of anxiety disorders may have separate symptoms, all of them share the following common signs as well –

  • Repetitive, uncontrollable and intrusive thoughts
  • Avoidance behaviors
  • Distress, panic and fear
  • Rapid breathing or shortness of breath
  • Anticipation of impending dangers or doom
  • Increased heart rate
  • Increased irritability
  • Trouble sleeping
  • Restlessness or inability to remain calm
  • Difficulty concentrating
  • Hot or cold flashes
  • Tingling sensations or numbness
  • Nausea & dizziness
  • Unexplained pains & aches
  • Tense muscles
  • Sweating
  • Fatigue or exhaustion
  • Dry mouth
  • Gastrointestinal (GI) problems

It should be noted that the symptoms can get worse due to consumption of specific medications, caffeine, alcohol and other substances.

Causes Of Anxiety

The exact causes for the development of anxiety disorders are not clearly understood. Experts believe that the condition may develop due to a combination of different factors. Some of the most common factors that may influence the onset include the following –

1. Genetics

Studies 30 have found that “genetic determinants play a major role in the etiology” of this disorder. Hence, you are more likely to develop this condition if you have a first degree family member with an anxiety disorder. Research 31 shows that the heritability of these disorders is around 30%-67%.

2. Environmental factors

Certain environmental and life stressors, like work pressure, family responsibilities and relationship issues can also make someone persistently anxious. One 2020 study 32 found that anxious feelings may occur more due to environmental factors than genetic predisposition. Researchers have observed that factors, such as family dynamics, religion, culture and adverse childhood experiences, like abuse and maltreatment, can affect our likelihood of experiencing anxiety. “Childhood trauma is considered to be a risk factor for developing anxiety as well as chronic pain,” explains another 2020 study 33 .

3. Brain chemistry

Changes in brain structure can also be an influencing factor as issues with electrical signals in our brain can influence how we experience fear and other emotions. Research 34 shows that these disorders are marked by a range of neuroanatomical, neurotransmitter and neuroendocrine disruptions. Moreover, pathological anxiety can cause “structural degeneration and impaired functioning of the hippocampus,” leading to higher risk of developing neuropsychiatric disorders, like dementia & depression, according to a 2016 study 35 .

4. Medical conditions

Medical causes like other health conditions 29 , side effects of medications, chronic pain or injuries or intensive surgery can also be contributing factors. Anxiety can often be associated with underlying medical conditions, such as thyroid, lung or heart conditions. Some common medical causes for the onset of this disorder may include –

  • Side effect, withdrawal or misuse of medications
  • Diabetes
  • Respiratory disorders like asthma
  • Irritable bowel syndrome
  • Heart disease
  • Chronic pain
  • Heart disease
  • Thyroid problems
  • Tumors

5. Substance use

Abuse or withdrawal from recreational or illicit drugs can also lead to anxious feeling in the long run. Although certain drugs can be used to reduce stress and anxiety, alcohol and substance use can often lead to an anxiety disorder. According to one 2019 study 36 , substances 37 like cocaine can often cause and be a consequence of anxiety.

Apart from these, some other risk factors may include –

  • Personality traits, like shyness & withdrawal
  • Gender 38
  • Sexuality 39
  • Race 40
  • Family historyHistory of menta
  • l illness
  • Childhood abuse
  • Trauma
  • Stressful life events, like loss of loved one
  • Low self-esteem

Diagnosis Of Anxiety Disorder

In order to diagnose the condition, a healthcare professional or a doctor may ask the patient about their symptoms, medical history and family history. Although there are no specific tests to diagnose this anxiety, a doctor or a mental health professional may recommend certain physical examinations and lab tests, like urine or blood or tests to rule out any underlying medical conditions that cause the symptoms. The doctor may also conduct some mental health evaluations using psychological questionnaires, anxiety scales & tests to better assess the patient. The doctor may also refer to the diagnostic criteria 41 established by the DSM-V and ICD-11. Apart from analyzing the symptoms, the doctor will also determine what particular type of anxiety disorder the patient is suffering from and what comorbid conditions or co-occurring disorders, such as depression, are present.

According to a 2017 study 42 , “Because anxiety symptoms can include avoidance behaviors, somatic complaints, social difficulties, and sleep disturbances, consideration of a differential diagnosis is important.” Differential diagnosis can include –

  • Obsessive-compulsive disorder
  • Attention-deficit hyperactivity disorder
  • Autism spectrum disorder
  • Hyperthyroidism
  • Pheochromocytoma
  • Arrhythmias
  • Asthma
  • Atrial fibrillation
  • Delirium
  • Diabetic ketoacidosis
  • Alcoholism
  • Substance abuse

Once the diagnosis is done properly, the doctor will devise an effective treatment plan that is focused on the recovery needs of the patient and family members.

Treatment Of Anxiety

If the symptoms of anxiety are affecting and impairing the patient’s ability to perform daily functions, then seeking medical help is essential. Treatment 43 typically involves a combination of medications and psychotherapy. According to a 2018 study 44 , both psychotherapy and pharmacotherapy are considered effective. However, developing the treatment plan may depend on certain factors such as –

  • Severity of symptoms
  • Needs & preferences of the patient
  • Durability and latency of the treatment
  • Anticipated side effects
  • Availability of the treatment

Treatment must also focus on any underlying condition, if present. Here are some of the most common and effective treatment options available for anxiety disorders –

1. Medications

Different types of medications may be prescribed by a doctor to treat anxiety and associated disorders. According to research 11 , common medications typically include –

  • Selective serotonin reuptake inhibitors (SSRIs)
  • Serotonin-norepinephrine reuptake inhibitors (SNRIs)
  • Beta-blockers
  • Mild tranquilizers
  • Sedatives
  • Tricyclic antidepressants
  • Anticonvulsants
  • Azapirones
  • Benzodiazepines

These medications help to balance chemicals in the brain and relieve the symptoms. “SSRIs, and possibly SNRIs, are the first-line treatments for most anxiety disorders,” explains a 2012 study 45 . Researchers 46 also believe that tricyclic antidepressants (TCAs) & monoamine oxidase inhibitors (MAOIs) are regarded as second-line treatment and are reasonably effective, but may have some safety and tolerability issues. Several studies 47 have also observed that benzodiazepines are “more effective than placebo,” in treating this disorder, especially generalized anxiety disorder (GAD). “Benzodiazepines (BZs) are still widely prescribed for the treatment of anxiety disorders despite many publications in the literature which favour antidepressants (ADs) instead,” explains a 2018 study 48 .

2. Psychotherapy

Psychotherapy 49 , talk therapy and counseling can enable the patient to better understand and regulate their own thoughts, emotions and behaviors. A therapist or a mental health professional, like a psychiatrist or a psychologist, can help the patient to understand the underlying causes of their fears and anxieties, gain new perspectives to approach triggers differently and develop helpful coping strategies. Therapy enables you to gain problem- solving skills to overcome your anxious thoughts and feelings. Studies 50 have shown that psychotherapy is highly effective in treating anxiety and mood disorders.

Cognitive behavioral therapy (CBT 51 ), a form of psychotherapy is widely recommended for these disorders as it helps to manage panic-inducing thoughts and behaviors and replace them with positive ones. Research 52 shows that CBT is an effective treatment approach for anxiety disorders. According to a 2015 study 53 , CBT is a short-term treatment focused on skills that helps to change maladaptive emotional responses by improving your thoughts & behaviors. The study adds “Cognitive behavioral therapy (CBT) has been shown to be effective for a wide variety of mental health disorders, including anxiety disorders. CBT has also been associated with improvements in quality of life in anxiety patients.”

Coping Strategies

Coping Strategies
Anxiety


Apart from medical treatment, certain self-help techniques can also help someone to cope with severe anxiety. Some of the these helpful strategies include –

1. Educate yourself about anxiety disorder

Learning about your condition will help you identify triggers and take steps before symptoms worsen.

2. Learn to relax

Certain relaxation techniques 54 , such as deep breathing, meditation, yoga and massage can help one soothe physical and emotional symptoms.

3. Develop stress management skills

Managing stress can help to overcome triggers and make challenges seem more manageable and less terrifying.

4. Engage in physical exercise daily

Regular exercise 55 and physical activity can help to improve the symptoms by releasing brain chemicals and promoting positive emotions.

5. Build a support network with your loved ones

Talk openly with friends and family members you trust. You can also join a local or online support group.

6. Follow the treatment plan

Strictly follow the instructions given by your doctor, take medicines as prescribed, attend therapy sessions regularly and inform your doctor about any concerns that you may have.

7. Avoid substances and alcohol

Stay away from illicit, recreational drugs and alcohol 56 . It is also important to avoid caffeine and nicotine as well.

8. Socialize

Attend social events and spend more time with your friends. Focus on developing healthy connections instead of withdrawing or isolating yourself.

9. Make healthy lifestyle changes

Certain lifestyle changes can be beneficial in coping with anxiety, such as –

  • Practice good sleep hygiene and get enough sleep
  • Eat a healthy and nutritious diet
  • Keep a journal & write your thoughts
  • Develop a positive mindset
  • Consult your doctor before taking over-the-counter (OTC) drugs or alternate remedies

Takeaway

Although anxiety is a normal emotion, anxiety disorders are mental health conditions that require treatment and support. Moreover, a healthy lifestyle and diet can also prove to be beneficial in reducing the symptoms and living a healthier life. However, if left untreated it can severely affect your ability to function in daily life. So if you are experiencing anxiety, make sure to consult a doctor or a mental health professional immediately.

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